leiomyomen

Leiomyomen are benign tumors derived from smooth muscle tissue (leiomyomas) that originate in smooth muscle cells. They are the most common benign neoplasm of the female reproductive tract and can also develop in other organs containing smooth muscle, such as the gastrointestinal tract, skin, or vascular walls.

The uterus is the most frequent site of leiomyomas. Uterine leiomyomas, commonly called fibroids, affect many people during reproductive years. They are typically estrogen- and progesterone-responsive, tending to grow during the reproductive years and often shrinking after menopause. Growth and symptoms vary by size and location within the uterus.

Symptoms range from none to significant. Many leiomyomas are asymptomatic. When present, symptoms can include abnormal uterine bleeding and heavy menstrual periods, pelvic pressure or pain, urinary frequency or constipation, and reproductive issues such as infertility or pregnancy complications. Size, number, and position of the tumors influence clinical presentation.

Diagnosis typically starts with pelvic ultrasound. MRI may be used in complex cases or for surgical planning. Histology is often obtained after removal and shows well-circumscribed, whorled bundles of spindle-shaped smooth muscle cells with low mitotic activity and no significant atypia; distinguishing benign leiomyomas from leiomyosarcoma is important, as the latter shows higher mitotic activity and atypia.

Management depends on symptoms, tumor characteristics, and reproductive goals. Asymptomatic cases may be observed. Medical options include GnRH agonists to shrink fibroids and treatments for bleeding or pain. Surgical options include myomectomy to spare the uterus or hysterectomy for definitive treatment. Non-surgical alternatives include uterine artery embolization and MRI-guided focused ultrasound. The prognosis is generally favorable; recurrence is possible, and malignant transformation to leiomyosarcoma is rare.